TRENDS IN HUMAN-IMMUNODEFICIENCY-VIRUS (HIV) INFECTION AMONG A PATIENT POPULATION OF AN INNER-CITY EMERGENCY DEPARTMENT - IMPLICATIONS FOR EMERGENCY DEPARTMENT-BASED SCREENING PROGRAMS FOR HIV-INFECTION

Personnel of inner-city emergency departments (EDs), which are frequen tly the only source of medical care for many patients, may be in a uni que position to detect human immunodeficiency virus (HIV) infection ea rlier than personnel at other recommended screening sites. To assist d evelopment of ED-based screening strategies for HIV infection, we unde rtook a serosurvey of HIV infection in adult patients attending an ED during a 6-week period in 1992 using an identity-unlinked technique an d compared our findings with data collected similarly in 1988. Of 1,60 6 patients, 183 (11.4%) were HIV-positive, compared with 6.0% in 1988. Seroprevalence rates of HIV infection among patients only at risk of heterosexual transmission increased more than fourfold (7% to 30.3%). CD4(+) cell counts were higher in those patients with undiagnosed HIV infection than in those with known HIV infection. Targeting minority p atients aged 25-44 years, intravenous drug users, and those patients a t heterosexual risk would have identified 87% of patients with new HIV infection, while requiring screening of 41% of the study sample. Targ eted voluntary screening programs in certain EDs would likely detect s ignificant numbers of new early HIV infections.